I'm the insurance commissioner for Washington state. Every day, desperate people seek help from my office.

One woman lost her job and health coverage, only to discover her husband needed a critical operation. Another couple, both 62, struggle to pay $1,400 a month. And a retired couple is trying to help their uninsured son — a heart-transplant recipient — pay $2,000 a month for medication.

Good, affordable health insurance eludes more and more of us. Many people are only one accident or serious illness away from bankruptcy. And even many of those with good coverage know it may not be there tomorrow. Across the country, this anxiety hangs over workers' and families' heads.

I had a front-row seat during the last major attempt at reform. Sixteen years ago, I was a congressman on a key House health subcommittee. We failed then. We cannot afford to fail again.

Some argue that we cannot afford to make major changes during tough economic times. They're wrong. We can't afford not to fix this. We outspend developed nations 2-to-1 on health care, yet end up with outcomes that more closely resemble those of economic developing countries.

Yes, we have some great care here. But fewer of us have access to it. And if we stay the course, we'll spend $33 trillion over the next decade for the same results. You'll pay that. So will your kids, and so will your grandkids.

The current system is not sustainable. We cannot support costs that rise three times the rate of inflation without losing coverage, care and quality. And don't think you're immune from those pressures because you get your coverage at work or through a government-run plan, like Medicare. (Yes, government-run.) We're all in the same boat. And it's sinking.

What Congress is considering now should have been done years ago. We need universal coverage, insurance that's not necessarily tied to your employer, and to stop letting pre-existing conditions wall people off from coverage. It should be affordable, with financial help for those who truly need it. A substantive, public-plan competitor to private insurance would help keep insurers honest and be another choice in the marketplace.

We need to get away from a system that pays doctors more for a flurry of tests and procedures. Instead, we must drive health care back to common-sense best practices. Technology can boost the efficiency of a health-care system awash in paper files and arcane billing codes. By giving more people access to routine care from the same doctor, we can nip problems before they become crises. Taxpayers and those with insurance are already helping foot the bill for those costly cases, even though many don't know it.

Lastly, a health insurance "exchange" would allow one-stop shopping for consumers trying to compare different plans. And it would allow people to pool their risk so the coverage isn't so expensive. As things stand today, a mom-and-pop business with a few employees can see its rates skyrocket if a worker is diagnosed with cancer, for example. That's because the pool of people is so small. An exchange would meld all those little groups into a much bigger pool, lessening the risks — and the threat of a big spike in premiums — to small employers.

All this is being debated by Congress. We cannot let this window of opportunity slip by again. Not for ourselves, our friends and our families. Yes, change is scary. But this is good change. I see and hear it every day: The status quo is bad and getting worse. We can do better. We must.

State Insurance Commissioner Mike Kreidler is a former member of the U.S. House of Representatives, and a former health-care provider.